| Acute Graft Pyelonephritis after Kidney Transplantation: Clinical Manifestations and the Impact on Long-term Allograft Outcome |
| Yu-Ji Lee, M.D.1, Na Ree Kang, M.D.2, Jung Eun Lee, M.D.1, Wooseong Huh, M.D.1, Sung-Joo Kim, M.D.3, Yoon-Goo Kim, M.D.1, Dae Joong Kim, M.D.1 and Ha Young Oh, M.D.1 |
Department of Medicine1
and Department of Surgery3
Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul Department of Internal Medicine2
Seoul Medical Center, Seoul, Korea |
| 임상연구 : Acute Graft Pyelonephritis after Kidney Transplantation: Clinical Manifestations and the Impact on Long-term Allograft Outcome |
| Yu-Ji Lee, M.D.1, Na Ree Kang, M.D.2, Jung Eun Lee, M.D.1, Wooseong Huh, M.D.1, Sung-Joo Kim, M.D.3, Yoon-Goo Kim, M.D.1, Dae Joong Kim, M.D.1 and Ha Young Oh, M.D.1 |
| Department of Medicine1, and Department of Surgery3, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul Department of Internal Medicine2, Seoul Medical Center, Seoul, Korea |
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| Abstract |
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Purpose:The objective of this study was to investigate the clinical manifestations and risk factors associated with acute graft pyelonephritis (AGPN) and its impact on graft outcome.
Methods:We performed a retrospective study reviewing the medical records of 272 recipients with a graft survival of more than 1 year among 291 recipients that had undergone kidney transplantation between January 1995 and December 1999.
Results:Twenty eight (10.3%) patients had at least one episode of AGPN during a follow-up of 7.3 years, and 14 (50%) among them had recurrent episodes. 31.5% of total AGPN episodes had no any urinary signs and symptoms and only had a fever and leukocyturia. Escherichia coli and Klebsiella, the most common pathogens isolated, were susceptible to ciprofloxacin in 48.6% of cases and to ceftriaxone in 94.3% of cases. Acute rejection was not associated with the occurrence of AGPN. However, female gender was a risk factor for acute rejection (risk ratio 7.11, p<0.001). Vesicoureteral reflux in allograft was found in 72.7% of the recipients with an episode of AGPN (16/22). There was a trend toward more frequent development of vesicoureteral reflux in recipients with recurrent AGPN episodes (54.6% in patients with a single episode vs 90.9% in patients with recurrent episodes, p= 0.074). On Cox regression/Time-dependent covariate analysis, AGPN had no significant association with the graft or patient survival.
Conclusion:AGPN is common after kidney transplantation, especially in women. However, AGPN was not associated with a poor long-term graft outcome. |
| Key Words:
Kidney transplantation, Pyelonephritis, Graft survival, Risk factors |
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